Bradycardia associated with remdesivir treatment in coronavirus disease 2019 patients: A propensity score-matched analysis

Remdesivir is an antiviral drug recommended for the treatment of COVID-19. The therapeutic benefits of remdesivir remain under investigation, with further literature emerging regarding its cardiac side-effect profile. The objective of this study was to investigate the association of remdesivir with bradycardia using a propensity score-matched analysis. Secondary outcomes included assessing in-patient mortality and hospital length of stay following remdesivir treatment for COVID-19. A single-institution retrospective study investigating treatment with and without remdesivir in 645 patients admitted for COVID-19 management was performed. Following treatment with remdesivir, patients were analyzed for episodes of bradycardia, defined in this study as 2 consecutive episodes of a heart rate <60 beats per minute. Matched cohorts were generated after controlling for potential confounders associated with remdesivir exposure. Subsequently, a propensity score-matched analysis was conducted to minimize selection bias and to account for the characteristics between the 2 comparison groups. In a sample of 645 COVID-19 patients, 58% were in the treatment group (Remdesivir+) and 42% were in the control group (Remdesivir-). 59% were males with a mean age of 57 ± 14.5 years. After propensity score matching, the remdesivir + group had a higher incidence of bradycardia (48.5% vs 30.7%, P = .028). The remdesivir + group was found to have a lower rate of in-patient mortality (1.0% vs 3.0% P < .001) and longer in-patient length of stay (13.7 vs 6.3 days, P < .001) compared to the remdesivir- group. Patients with COVID-19 had a greater prevalence of bradycardia following treatment with remdesivir. For these patients, remdesivir reduced in-patient mortality compared with untreated COVID-19 patients.